Exploring integration of support for co-occurring substance use-related needs in interdisciplinary traumatic brain injury treatment for military service members and Veterans

Abstract: Objective: To explore initial outcomes (treatment entry and completion and staff feedback) for an interdisciplinary military traumatic brain injury (TBI) treatment program with individualized support for co-occurring substance use (SU). Design: A quality improvement effort was undertaken to develop an integrated model of care for TBI with support for service members and veterans (SM/Vs) with co-occurring SU. We describe treatment entry and completion outcomes, along with staff feedback, collected over 26 months of program implementation. Setting: An intensive outpatient program (IOP) for SM/Vs with TBI, administered by a not-for-profit hospital. Participants: Three hundred sixty-four SM/Vs applying for TBI treatment (85.2% male, 28.3% active service, median age=41 (IQR ± 12)). Interventions: An Integrated Care Model for TBI+SU was developed and flexibly applied to support client needs, including modifications to assessment, intervention, and follow-up support related to SU. Main Outcome Measures: We report on instances of non-completion due to SU, percentage of admission denials due to SU, demographic and clinical predictors of entering care, and qualitative feedback from treating clinicians. Results: Over twenty-six months, 188 individuals entered care, and just seven who entered the IOP did not complete, with one of these instances due to SU. Clinician attitudes indicate optimism about the Integrated Care Model. Predictors of entering care, analyzed using logistic regression with recursive feature elimination, included multiple demographic (sex, race, location, service status) and clinical (SU and psychiatric history, brain injury symptom severity) characteristics. Conclusions: An interdisciplinary TBI treatment environment holds promise as a setting for incorporating SU-related support to enhance entry and completion for more SM/Vs.

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